1. Introduction
Conventional right ventricular pacing (RVP) can cause electrical and mechanical dyssynchrony and is associated with increased risks of cardiac remodeling, pacemaker-induced cardiomyopathy, heart failure, and mortality.1, 2These deleterious effects have driven the search for alternative pacing sites. Conduction system pacing (CSP) is one such alternative that aims to directly activate the His-Purkinje conduction system thereby preserving synchronous ventricular activation and is thus deemed to be a more physiological alternative to conventional RVP.
Left bundle branch area pacing (LBBAP), proposed by Huang et al. in 2017,3 has emerged as a new physiological conduction system modality that has a lower, more stable threshold and achieves a paced QRS duration similar to that of His bundle pacing (HBP).4 LBBAP presents a simpler implantation technique, shorter fluoroscopy duration, and a procedure time with a steeper learning curve compared to HBP; thus, LBBAP is currently widely used as an alternative for CSP and considered the first strategy for patients in whom a high burden of ventricular pacing is anticipated.5, 6
In most cases, LBBAP has been performed exclusively using a lumen‐less lead (LLL) with a fixed helix design (SelectSecure 3830 pacing lead, Medtronic Inc., Dublin, Ireland) and a pre-shaped sheath dedicated to this lead (C315His, Medtronic Inc.),3, 7 both of which are unavailable in some centers and countries. Meanwhile, De Pooter et al. reported their early experience with LBBAP using a standard stylet-driven lead (SDL) in 20 cases, and the initial results showed feasibility and safety.8 However, most researches have reported initial experience with LBBAP, and only few studies have focused on the learning curves for LBBAP. Moreover, no data exists on the learning curve for LBBAP with SDL. In this study, we aimed to evaluate the success rate, fluoroscopy and procedure time, lead and electrocardiography (ECG) parameters, and learning curve of LBBAP using SDL, and to compare these parameters with those of conventional RVP.